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Gastroenterology Coding Alert

CMS Grants RVU Increases to 4 Codes in the 43235 'Family'

Published on Fri May 07, 2004

Base endoscopy code is worth 7.59 nonfacility RVUs

Gastroenterology coders have no choice but to master the 43235 endoscopy family -- the code group is far too frequently reported to neglect. But in 2004, at least Medicare has given offices added incentive to get the codes right: extra cash.

The 2004 edition of the Physician Fee Schedule Update featured an increase in relative value units (RVUs) for a quartet of codes in the 43235 family. (The conversion factor for 2004 is $37.3374, up from $36.8756 in 2003.)

Rates Vary by Facility

Here is a list of the four codes that Medicare made significantly more profitable with a 2004 RVU bump. We have provided RVUs for both facility (i.e., office) procedures and nonfacility procedures, which include the cost of providing equipment, space, etc., where they are applicable.

  • 43235 -- Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen(s), by brushing or washing (separate procedure)
    2004 RVU:     3.62 for facility, 7.59 for nonfacility

  • 43236 -- ... with directed submucosal injection(s), any substance
    2004 RVU: 4.35 for facility, 9.41 for nonfacility

  • 43239 -- ... with biopsy, single or multiple.
    2004 RVU: 4.27 for facility, 8.62 for nonfacility

  • 43258 -- ... with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique
    2004 RVU: 6.65 for facility, nonfacility N/A.

    New Members of the Family

    CPT also added a pair of codes to the 43235 family:

  • 43237 -- Upper gastrointestinal endoscopy including esophagus, stomach and either the duodenum and/or jejunum as appropriate; with endoscopic ultrasound examination limited to the esophagus.  
    2004 RVU: 5.86 for facility, nonfacility N/A

  • 43238 -- ... with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s), esophagus (includes endoscopic ultrasound examination limited to the esophagus)
    2004 RVU: 7.26 for facility, nonfacility N/A.

    Editor's note: The 2004 RVU amounts come from Issue No. 1297 of the Medicare Physician Fee Schedule Calendar Year 2004 Interim Final Rule. The actual RVUs may vary slightly by region depending on the geographic adjustment.

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